Travel PrecautionsPeople in their home environment live in a state of equilibrium with the locally occurring strains of microorganisms and with the altitude and climatic conditions of the region. However, this is an unstable equilibrium that can be upset even in the home environment by factors such as the arrival of an unfamiliar microorganism, seasonal changes in climate and unusually stressful situations. The many physical and environmental changes encountered during international travel may upset this equilibrium to an even greater extent: sudden exposure to significant changes in altitude, humidity, microbial flora and temperature, exacerbated by stress and fatigue, may result in ill-health and an inability to achieve the purpose of the journey. The risks associated with international travel are influenced by characteristics of the traveller (including age, sex and health status) and by characteristics of the travel (including destination, purpose and duration). Forward planning, appropriate preventive measures and careful precautions can substantially reduce the risks of adverse health consequences. Although the medical profession and the travel industry can provide a great deal of help and advice, it is the traveller's responsibility to ask for information, to understand the risks involved, and to take the necessary precautions for the journey. Travel-related risks Destinations where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks for the health of travellers, unless there is pre-existing illness. This applies to business travellers and tourists visiting most major cities and tourist centres and staying in good-quality accommodation. In contrast, destinations where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services do not exist, and clean water is unavailable may pose serious risks for the health of travellers. This applies, for example, to personnel from emergency relief and development agencies or tourists who venture into remote areas. In these settings, stringent precautions must be taken to avoid illness. The duration of the visit and the behaviour and lifestyle of the traveller are important in determining the likelihood of exposure to many infectious agents and will influence decisions on the need for certain vaccinations or anti malarial medication. The duration of the visit may also determine whether the traveller may be subjected to marked changes in temperature and humidity during the visit, or to prolonged exposure to atmospheric pollution. The purpose of the visit is critical in relation to the associated health risks. A business trip to a city, where the visit is spent in a hotel and/or conference centre of high standard, or a tourist trip to a well-organized resort, involves fewer risks than a visit to remote rural areas, whether for work or pleasure. However, behaviour also plays an important role; for example, going outdoors in the evenings in a malaria-endemic area without taking precautions may result in the traveller becoming infected with malaria. Exposure to insects, rodents or other animals, infectious agents and contaminated food and water, combined with the absence of appropriate medical facilities, makes travel in many remote regions particularly hazardous. Medical consultation before travel Travellers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. This consultation should preferably take place 4–6 weeks before the journey, particularly if vaccination may be required. However, last-minute travellers can also benefit from a medical consultation, even as late as the day before travel. This consultation will determine the need for any vaccinations and/or anti malarial medication, as well as any other medical items that the traveller may require. A basic medical kit will be prescribed or provided, supplemented as appropriate to meet individual needs. A dental check-up is advisable before travel to developing countries or prolonged travel to remote areas. This is particularly important for people with chronic or recurrent dental problems. Medical kit and toilet items Sufficient medical supplies should be carried to meet all foreseeable needs for the duration of the trip. A medical kit should be carried for all destinations where there may be significant health risks, particularly those in developing countries, and/or where the local availability of specific medications is not certain. This kit will include basic medicines to treat common ailments, first-aid articles, and any special medical items that may be needed by the individual traveller. Certain categories of prescription medicine should be carried together with a medical attestation, signed by a physician, certifying that the traveller requires the medication for personal use. Some countries require not only a physician but also the national health administration to sign this certificate. All medicines should be carried in the hand luggage to minimize any risk of loss during the journey. A duplicate supply carried in the checked luggage is a safety precaution in case of loss or theft. Toilet items should also be carried in sufficient quantity for the entire visit unless their availability at the travel destination is assured. These will include items for dental care, eye care including contact lenses, skin care and personal hygiene. |